Provider Demographics
NPI:1962926170
Name:MANGANO, JARED LUCAS (RPH)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:LUCAS
Last Name:MANGANO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E 120TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80233-5711
Mailing Address - Country:US
Mailing Address - Phone:303-280-6273
Mailing Address - Fax:303-222-7596
Practice Address - Street 1:1001 E 120TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233-5711
Practice Address - Country:US
Practice Address - Phone:303-280-6273
Practice Address - Fax:303-222-7596
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0021830183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPHA.0021830OtherSTATE PHARMACIST LICENSE